A Retrospective Study Describing Documentation of Advance Care Planning in a Long Term Care Setting

Problem: Increased life expectancy and aging baby boomers will increase the population of those 65 years of age and older to nearly 20% of the United States population by 2030. It is estimated that 40-70% of this population will need long term care during their lifetime, and by 2020, 40% of patients in long term care will die there. As patients age, advance care planning (ACP) and advance directives (AD) should be completed to make their wishes known to healthcare providers and family. Despite legal requirements for completion at entry to healthcare settings, less than 95% of hospitalized patients and 50% of long term care patients have an AD or ACP. Significance: Advance care planning increases patients’ quality of life, may decrease stress and ease decision making at end of life for patients and families. There is little research on the completion levels of ACP in long term care. Purpose: The primary purpose of this retrospective study is to describe the level of ACP documentation in a long term care setting. A secondary purpose is to describe potential relationships between demographic, past medical history (PMH) and ACP variables Design: Retrospective descriptive chart review Results: More than 76% of patients at the facility were over the age of 65. Less than 43% of patients had an AD listed in their chart, and less than 31% of patients had an AD completed prior to admission at the long term care facility. At admission to the facility, only 7 of 29 (12.7%) patients that came from the hospital had an AD or ACP documented. Seven patients at the facility were listed as Hospice patients, and only three of seven (42.8%) had ACP documented. Only 33% of patients had an ACP meeting at the facility listed in their chart. Of ACP meetings that occurred, there was a high level of patient and family involvement in end of life decision making. A correlation was found between Alzheimer’s disease and ACP completion, as well as Medicaid insurance and ACP completion